First published online in 2022 with a focus on promote medical sciences generated from Basic Sciences, Clinical, and Community Research to Integrate Researches in All Aspects of Human Health. Microbiology, Biotechnology and Conservation published 2 (two) times a year in April and October.
PPDS Bedah Fakultas Kedokteran Universitas Mataram
ABSTRACT Meningiomas are tumors of the central nervous system that originate in the meninges and spinal cord. It is a benign, slow-growing neoplasm thought to originate from meningothelial cells. Meningiomas are typically oval lesions attached to the dura mater. They are most commonly located supratentorial to the calvaria or at the base of the meninges. Meningiomas can also be found in the tentorium, intraventricularly, or in the cerebellopontine region. Meningiomas arise from meningothelial cap cells that are normally distributed throughout the arachnoid trabeculation. The highest concentration of meningothelial cells is found in the arachnoid villi of the dural sinuses, cranial nerve foramina, middle cranial fossa, and cribriform plate. Additionally, meningiomas are commonly found over the convexity, along the falx, and at the base of the skull. Keywords: Meningioma, tumor
Copyright (c) 2026 Lombok Health And Science Journal
ABSTRACT The thyroid gland is the largest organ of the endocrine system. Disorders of the thyroid gland present the most common clinical manifestations compared to other organs of the endocrine system. Thyroid cancer has a high incidence and is one of the leading causes of death worldwide, accounting for 7.6 million deaths (13% of all deaths) in 2008, with this figure continuing to increase every year. Along with the increasing prevalence of thyroid cancer in Indonesia, this study was conducted to determine the proper diagnosis and management of thyroid cancer. Keywords: Thyroid carcinoma, diagnosis, imaging, anatomic pathology examination, thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels
Thyroid carcinoma, diagnosis, imaging, anatomic pathology examination, thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels
A 44-year-old male with Raynaud's Phenomenon and Systemic Sclerosis : CASE REPORT
ABSTRACT Raynaud's Phenomenon is a condition caused by vascularization disorders with episodic responses to cold temperatures or emotional stress that can cause changes in skin color to pale, cyanosis, and erythema and has symptoms such as numbness, pain, and tingling in the extremities. This case report discusses a 44-year-old male patient with a primary complaint of blackened left fingers and left feet. This complaint has been present for the past 6 months, accompanied by numbness. When the temperature is cold, the hands turn blue and return to red when the temperature normalizes. The patient has a smoking habit of 1 pack per day. There is a history of seizures felt on the left side of the body, and the patient is aware of the seizures. Keywords: Raynaud's Phenomenon, vasospasm, skin color
Raynaud's Phenomenon, vasospasm, skin color
The Relationship Between Body Mass Index, Physical Activity, and Depression Levels with Fasting Blood Glucose Levels in Patients with Type 2 Diabetes Mellitus at the Internal Medicine Clinic of Praya General Hospital
ABSTRACT Background: Diabetes mellitus is a health problem that accounts for more than 90% of cases in every country, and almost all diabetes mellitus is classified as type 2 diabetes. One of the districts in West Nusa Tenggara that has the second highest case of type 2 diabetes mellitus is Central Lombok Regency with 3,995 patients. Many factors influence blood glucose levels, particularly fasting blood glucose levels in individuals with type 2 diabetes mellitus, including body mass index, physical activity, and depression levels. Objective: To determine the relationship between body mass index, physical activity, and depression levels with fasting blood glucose levels in patients with type 2 diabetes mellitus at the Internal Medicine Polyclinic of Praya Regional General Hospital. Method: This study employed quantitative research methods with a cross-sectional design and purposive sampling techniques. The study was conducted at the Internal Medicine Polyclinic of Praya Regional General Hospital from September 8 to 23, 2023, with a total of 100 respondents. The data were analyzed using Spearman's Rank Correlation test with SPSS 25. Results: There was a significant relationship between body mass index and fasting blood glucose levels with a p-value of 0.041. There was a significant relationship between physical activity and fasting blood glucose levels with a p-value of 0.008. There was no significant relationship between depression levels and fasting blood glucose levels with a p-value of 0.922. Conclusion: There was a significant relationship between body mass index and physical activity with fasting blood glucose levels. However, there was no relationship between depression levels and fasting blood glucose levels in patients with type 2 diabetes mellitus. Keywords: Activity, Diabetes Mellitus Type 2, Body Mass Index, Fasting Blood Glucose, depression levels.
Physical Activity, and Depression Levels with Fasting Blood Glucose Levels
COSTA FRACTURE PATIENTS WITH CLIPPING COSTAE MANAGEMENT AT THE WEST NUSA TENGGARA PROVINCIAL GENERAL HOSPITAL FOR THE PERIOD JANUARY 2021 - JUNE 2023
Background: The ribs play a role in protecting the organs in the chest cavity. The ribs are also attached to the vertebrae to increase stability. Farktur costae occurs when there is a significant force on the costae or ribs. Costae fractures usually occur at the point of impact or posteriorly which is structurally the weakest part which at a severe rate can lead to the occurrence of flail chest. This causes pain at the fracture site, bruises, crepitations, and decreased ability to do full inspiration. With increasing morbidity and mortality rates due to costae fractures and affecting the quality of life of patients. Therefore, appropriate follow-up is needed in handling the costae fracture, which can be done surgical / operative fixation (clipping costae) more useful after nonoperative action. Method: This study is a descriptive study that uses secondary data in the form of x-ray (radiology) results and medical records of costae fracture patients at the West Nusa Tenggara Provincial General Hospital for the January 2021 – June 2023 period. Results and Conclusions: There were 19 cases of costae fractures with clipping costae management handled by NTB Provincial Hospital in the January 2021 – June 2023 period. The incidence of costae fractures is more prevalent in the age group of 45-54 years (31.58%), dominated by the male sex most patients experience multiple costae fractures with comorbidities can be pneumothorax, pulmonary contusion, hemothorax, and pleural effusion. The treatment performed on costae fracture patients is in the form of clipping costae which aims to stabilize and accelerate the healing process with minimal complications from the procedure. Operative management in the form of surgical fixation has been widely done with advantages that can reduce the number of complications due to costae fractures. Surgical fixation with clipping costae is considered a safe procedure with a very low risk of complications with satisfactory long-term results. The prognosis depends on the severity of the trauma suffered. Keywords: HD, CD
Copyright (c) 2024 Lombok Health And Science Journal
VASCULAR ACCESS EMERGENCIES IN THE DIALYSIS PATIENT IN NTB PROVINCIAL GENERAL HOSPITAL: A RETROSPECTIVE STUDY
ABSTRACT Background: Hemodialysis (HD) is the most common renal replacement therapy modality in patients with CKD with a prevalence of up to 89%. One method to gain access to hemodialysis quickly is central venous catheterization using a double lumen catheter (CDL). However, the use of temporary CDLs increases the risk of complications such as thrombosis and infection. Currently, data related to CDL in NTB General Hospital is not available in full, both the incidence, germ patterns and antimicrobial sensitivity, causes of CDL emergencies and dysfunction. Researchers are interested in examining the factors that contribute to the incidence of emergency CDL insertion in HD patients at NTB General Hospital. Method: This study was a retrospective observational study. The samples of this study were patients who performed double lumen hemodialysis catheter vascular access measures in the OK CITO room of the NTB Provincial Hospital taken was from January to March 2024. Results and Conclusions: The total sample consisted of 60 (65.9%) males and 31 (34.1%) females. The majority of the samples were from the adult age group with 59 (64.8%) people. The location of CDL insertion was the dextra internal jugular vein 86 (94.5%), sinistra internal jugular vein 3 (3.3%) and femoral vein 2 (2.2%). The most common risk factor indicating CDL insertion was due to CDL detachment 24 (26.4%). it is necessary to recognize the signs of complications from kidney disease so that CDL insertion is carried out immediately as access to hemodialysis. In addition, CDL maintenance is also very required to ensure the smooth delivery of therapy and prevent complications that can complications that may arise from CDL use, especially in patients with long-term use and and to consider the use of other vascular access options. Keywords: HD, CD
CHARACTERISTICS OF HEPATIC ABSCESS PATIENTS UNDERGOING TREATMENT AT NTB PROVINCIAL HOSPITAL FOR THE PERIOD 2020-2023
Background: A liver abscess is defined as a mass containing pus that can arise due to injury to the liver or intra-abdominal infection that spreads from the portal circulation. The annual incidence rate is approximately 2.3 cases per 100,000 people. Men are affected more often than women. Age plays a role as a factor that determines the type of abscess that develops, where those aged 40-60 years are more susceptible to non-traumatic liver abscesses and most of them are reported to be pyogenic. In developing countries, amoebic liver abscess is more common than pyogenic liver abscess. The incidence of liver abscesses that occur in the NTB Provincial Regional Hospital is still unknown, but the presence of protozoa or bacteria that cause liver abscesses is often found in Indonesia. This study aims to determine the characteristics of liver abscess patients undergoing treatment at the NTB Provincial Regional Hospital for the 2020-2023 period. Method: This research is a retrospective descriptive study with a cross-sectional design. The sampling technique in this study was simple random sampling, which was obtained from secondary data in the form of medical records of all liver abscess patients undergoing treatment at the NTB Provincial Regional Hospital for the period 2020 - 2023. Results and Conclusions: From this study it was found that the characteristics of liver abscess patients undergoing treatment at the NTB Provincial Regional Hospital were mostly men, with the largest age group being 50 - 59 years old (27.5%), the highest number of diagnoses of liver abscess without complications were 132 patients (72.5%), with complications obtained by Peritonitis generalista ec ruptured liver abscess in 38 patients (20.9%). The main antibiotic used is Metronidazole, as well as additional antibiotics including Cefrtiaxone, Levofloxacin, Ceftazidine, Meropenem, Cefoperazone and Moxifloxacin. The most common procedures performed were laparotomy and liver abscess drainage (75.8%), several other procedures such as adhesiolysis (20.9%), liver resection (2.2%), liver repair (0.5%), cecum repair (0.5%), and long Treatment for liver abscess patients in this study was in the range of 6 – 10 days (54.9%) with an average of 7.7 days. Keywords: Liver abscess, characteristics, NTB Provincial General Hospita
THE CHALLENGING OF DIAGNOSIS, TREATMENT, AND EDUCATION IN PATIENT WITH BUERGER'S DISEASE: A CASE REPORT FROM REMOTE AREA
Background: Thromboangiitis obliterans (TAO) or Buerger’s Disease is a chronic inflammatory disease. If not treated early and adequately, TAO can result in limb amputation. The study regarding TAO in women is rare and limited. Also how difficult it is to diagnose and educate patients with TAO, especially in remote areas Case Presentation: A 38-year-old woman came to the emergency room with the chief complaint of pain and darkening in toes and hands 2 months ago, especially when it is cold. The patient did not come to the public health facility but was treated with traditional medicine according to local beliefs. History of smoking was denied. The localized status was found gangrene in toes and fingers, ulcer in toes, and oedema in legs. Allen's tests were positive. Dorsalis pedis arteries were palpable. ABI wasn’t performed. Laboratory examination showed an increased liver function. Cardiomegaly, Lung oedema, and minimal right pleural effusion were shown in Chest X-ray. History taking, clinical finding, and laboratory finding suggested the patient to amputation but the patient refused it. The Patient was treated by antibiotic, analgetic, anticoagulant, and double. After 3 days of treatment, the patient was discharged and asked to return to the outpatient care for education about amputation. Discussion: Most patients are aged 20-45 years. Men are more common than women. The etiology of TAO is unknown, but cigarette exposure is still associated with TAO. The role of hypercoagulability in the pathogenesis of TAO has been proposed. Elevated plasma homocysteine has been reported in patients with TAO. There was a strong link between the plasma Hcy concentration and Liver Fibrosis. We assessed the patient with TAO regarding suspect hypercoagulability affected by increased liver function. Difficult to diagnose due to patient denied smoking history and other imaging and laboratory tests weren’t performed. Patients with TAO who have elevated homocysteine also have a higher rate of amputations. Education is a key role for understanding the concept of health. Countries with higher education levels are more likely to have better national health conditions. We can conclude that lower levels in tertiary education affects a country’s health situation in terms of premature mortality. Conclusion: It is difficult to diagnose Buerger's disease or thromboangiitis obliterans because of the atypical complaints, minimal risk factors, and limited facilities for imaging and other laboratory tests. The difficulty of educating patients to get the best treatment is also a challenge for general practitioners, especially in remote areas Keywords: Buerger’s disease, thromboangiitis obliterans, woman, remote area, education level
NATURAL HISTORY AND TREATMENT OF DEEP-SEATED BRAIN ARTERIOVENOUS MALFORMATIONS
Background: Brain arteriovenous malformations (AVM) might be asymptomatic. The unruptured AVM was commonly found in patient with symptoms like persistent headaches and seizure. The ruptured AVM was 35.5% annually and usually involved deep and large structures. Spetzler-Martin grading system was commonly used to evaluate the outcome and treatment options of AVM. Aim: this case report will provide information about Spetzler-Martin grade III AVM in a 26-year-old male patient with a history of throbbing headaches and a history of VP shunt procedure. Case: A 26-year-old man with the main complaint of a headache that felt like it was throbbing and continuous. Nausea and vomiting were present. History of similar complaints in 2015. History of VP shunt in 2015 due to hydrocephalus. In the head CT scan we found an iso-hyperdense lesion of ill-defined density involving the left thalamus, left basal ganglia. After adding contrast, a serpiginous tubular lesion was seen forming a nidus size Â±AP 2.77 x LL 1.96 x CC 3.72 cm with draining veins in the vein of Galen, a hyperdense lesion appears filling the left lateral ventricle and third ventricle, a VP shunt is installed through the right frontal region with the distal end in the left lateral ventricle. Discussion: Our patient was diagnosed with Spetzler-Martin grade III which has to be treated multimodally such as pre-surgical endovascular embolization followed by microsurgery or radiosurgery. Endovascular embolization may reduce the risk of bleeding in the following surgery Conclusion: Bleeding is commonly found in AVM, consisting of half of the total cases. The risk of bleeding increase in deep and large structure of AVM in the brain, usually found in Spetzler-Martin grade III. Keyword: AVM, Spetzler-Martin Grading System, Deep
A 14-Year-Old Boy with Neurogenic Thoracic Outlet Syndrome: A Case Report
Background: Thoracic outlet syndrome (TOS) is a complex condition that involves the neurovascular bundle located between the scalene triangle and the inferior border of the axilla. TOS represents a wide variety of clinical symptoms and there is no single test available for establishing the definitive diagnosis. This case report aims to report the clinical history, clinical features, imaging findings, and treatment of a patient with neurogenic TOS secondary to suspected cervical muscle compression due to cervical dextroscoliosis, accompanied by patent ductus arteriosus. Case Presentation: A-14 years-old boy reported progressive weakness in his right hand. The patient also complains of headaches and tiredness every time after exercise since 3 years ago and progressive loss of body weight. Physical examination revealed a lower motor neuron type of superior paraparesis with gradual progressive onset on the right upper limb, accompanied by weakness of the deltoid, biceps, triceps, and finger muscles. Adson’s test of the right upper limb showed positive results. MRI and CT scan of the spine showed a cervical dextroscoliosis causing a mild bilateral neural stenosis and minimal right thoracal scoliosis. A continuous murmur grade 3/6 intercostal space II-III was heard on heart auscultation. Echocardiography showed a patent ductus arteriosus. The patient was scheduled for electromyography and nerve conduction velocity test. Discussion: Neurogenic TOS is a chronic compressive brachial plexopathy where the brachial plexus is pressed anteriorly and upwardly by the cervical rib arising elongated transverse process of C7, with the symptoms characterized by pain, tingling, numbness, or motoric weakness in the upper or lower arm. Multiple tests and examinations are needed to establish a definitive diagnosis. Treatment available for neurogenic TOS included conservative treatment with physiotherapy for posture and shoulder movement correction. Conclusion: TOS is a condition that could cause a variety of symptoms. Appropriate investigations and multiple diagnostic tests are needed for establishing the diagnosis. Patient’s history, clinical presentation, and examination could help eliminates the differentials, with imaging and electrophysiological testing helps identify the etiology. Keywords: Thoracic outlet syndrome, patent ductus arteriosus, scoliosis
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A HUGE RIGHT STAGHORN RENAL STONE : A CASE REPORT
Introduction: Urolithiasis is a very common problem. Open stone surgery is used less commonly due to its invasiveness and availability of above mentioned techniques. We introduce a case, that due to heavy and complex stone burden and increased chance of failure of percutaneous nephrolithotomy, Open stone surgery is performed and preferred for stone removal. Case presentation: The patient is a 58-years-old, male, had previously examined at the Dompu Hospital and referred to Urology Departement in RSUDP NTB due to a large right Staghorn kidney. After full evaluation and due to extensive spread of stone horns to the even peripheral calyces, open stone surgery performed successfully, that postoperative dynamic renal studies revealed, and evaluate kidney function. Conclusion: In spite of wonderful advances in endourologic stone surgery, open stone surgery still has its role, but it must be done in experienced centers with good surgical expertise to retain good and make acceptable functional kidney, postoperatively
CORRELATION BETWEEN MANNITOL INTERVENTION AND ELECTROLYTE IMBALANCE IN TRAUMATIC BRAIN INJURY PATIENTS OF REGIONAL GENERAL HOSPITAL OF WEST NUSA TENGGARA PROVINCE
Background: Traumatic brain injury (TBI) is a commonly occurring injury following traffic accident. The most common complication following TBI is electrolyte imbalance and might be happen due to mannitol use. This research aims to know the correlation between mannitol intervention and electrolyte imbalance (natrium, kalium and chloride) in TBI patients of Regional General Hospital of West Nusa Tenggara Province. Methods: This is a retrospective research with cross–sectional design. This research was done in Regional General Hospital of West Nusa Tenggara Province. Samples were collected by medical records of TBI patients from 2018 to 2019 which had met the inclusion criteria and then tested with correlation comparative test. Results: From 160 samples that were obtained, 146 samples had electrolyte data, then categorized into those who were given mannitol (73,29%) and those who were not given mannitol (26,71%). The most common electrolyte imbalance was chloride (70,55%) which in hyperchloremia condition, followed by kalium (30,82%) with hyperkalemia and natrium (28,08%) with hyponatremia. Mannitol is most commonly given for one day and has the mean intervention of 2.6 days. Length of mannitol intervention and electrolyte levels were not normally distributed. There was no statistically significant difference between mannitol intervention and electrolyte imbalance (p=1.000, p=1.000, p=0.481) and length of stay on patients with no mannitol intervention and electrolyte imbalance (p=0,856, p=0,303, p=0,347). Conclusion: This research shows no correlation between the length of mannitol intervention and electrolyte imbalance (represented by natrium, kalium, and chloride) in TBI patients of Regional General Hospital of West Nusa Tenggara Province. Keywords: mannitol intervention, electrolyte imbalance, traumatic brain injury.
Systematic Review: Analysis of the Correlation between Neuropathic Pain and VEGF Level
Neuropathic pain is caused by a lesion or disease of the somatosensory system, including peripheral fibres (Aβ, Aδ and C fibres) and central neurons, and affects 7–10% of the general population. Multiple causes of neuropathic pain have been described and its incidence is likely to increase owing to the ageing global population, increased incidence of diabetes mellitus and improved survival from cancer after chemotherapy. Literature search through database PUBMED using the keyword “neuropathic painâ€ combined with several terminologies such as: 'vascular endothelial growth factor', and 'VEGF'. We take only randomized control trial with English language. We excluded studies that specifically examined another induceable factor which can also cause neuropathic pain. Twenty four hundred and two hundred sixty seven kinds of literature were found, 53 of which were related to neuropathic pain and VEGF, only 6 included the study criteria. The occurrence of neuropathic pain is closely related to increased levels of VEGF-A bound to its receptor, namely VEGFRs. Increased VEGF-A can occur in both the central and peripheral nervous systems which is influenced by various conditions such as hypoxia, inflammation, leukocyte accumulation, increased blood sugar levels in diabetes mellitus, and malignancy. Stem cell therapy with VEGFA has been developed and can be a therapeutic option in neuropathic pain. Keywords: Neuropathic pain, vascular endothelial growth factor
Systematic Review: Identifying The Most Common Type And The Mostly Shown Clinical Manifestations Of Brain Herniation In Traumatic Brain Injury
Background: Brain herniation occurs when there is something in the brain that pushes brain tissue. Brain herniation is a mechanical dislocation of brain organs to other regions due to mass, trauma, neoplastic, ischemic or infection. Because the herniation itself causes high pressure on certain brain structures, it is fatal. Hence at all hospitals, the first action performed is nothing but reducing intracranial pressure.On neurological examination, there is a decrease in the degree of consciousness. Depending on the severity of the herniation, interference with one or more brainstem reflexes as well as the function of the cranial nerve may occur. Patients will also show a consistent inability to breathe and irregular heartbeats.. Methods: Using established systematic review methods, three databases (PubMed, Cochrane, ScienceDirect) with publication time before June 2021. We only include English literature in this review. Inclusion criteria was the study that published at the last 10 years, and only take a study that discuss about brain herniation in traumatic brain injury, the exclusion criteria that this review didn’t take an article journal as areference. Results and conclusion: Ten studies (more than 1000 patients) were included.The current researches about the most common type and the most shown clinical manifestation of brain herniation in traumatic brain injury have been studied for the past few years, the result shows that most common type of the brain herniation is supratentorial herniation (transcalvaria/ekstracranial herniation (40%), transtentorial/central herniation (30%), uncal herniation (30%)). While The most common clinical manisfestation of brain herniation in traumatic brain injury based on this research are dilated pupil and decreased of consciousness. Keywords: Most common type, Clinical Manifestation, Brain Herniation, Traumatic Brain Injury, Systematic review.
LEFT CA MAMMAE WITH FEBRILE NEUTROPENIA : A CASE REPORT
Introduction: Breast cancer is the most common cancer diagnosed, especially in women, accounting for more than 1 in 10 new cancer diagnoses each year. Physical examination, imaging and biopsy must be done to diagnose breast cancer.1,2 Staging is performed to define prognosis and guide treatment recommendations for patients with a similar prognosis. Chemotherapy, hormone therapy, and targeted therapy are the systemic therapies used in breast cancer management. The therapies option are has an side effect, especially chemotherapy. Chemotherapy induced neutropenia is a common toxicity caused by the administration of anticancer drugs. This side effect are life-threatening infections and alter the chemotherapy schedule. Case presentation: A female 50-years-old patient with left breast cancer on chemotherapy. She already has 3 times chemotherapy session and now had a fever with leucocyte result is 520 mg/dl and neutrophilia is 1.9 mg/dl. The patient has a history of painless lump in left breast since 11 months ago and growing proggresive. From physical examination, the lump with an ulcer with size 6x7x3cms and palpable hard consistency lump size is 8x8x5cms with irreguler edges and immobile. Patient had a biopsy examination with result invasive carcinoma ; high grade. From chest xray and USG Abdomen no finding sign of metastatic. Patient had an neo adjuvant chemotherapy Conclusion: Breast cancer is cancer of the breast tissue. Risk factors for breast cancer are divided into two, namely risk factors that cannot be changed (gender, age, genetic factors, previous cancer history, race and ethnicity, menstrual history and history of chest radiation) and those that can be changed (history of contraception, history of pregnancy, hormone therapy after menopause, breastfeeding, alcohol consumption, and obesity). Therapy for breast cancer is divided into five, namely surgical therapy, radiotherapy, chemotherapy, biologic therapy, and hormonal therapy. The goal of breast cancer therapy is to increase the survival rate and quality of life of patients.
Copyright (c) 2023 Lombok Health And Science Journal
Case Report : Chronic Subdural Hematoma from Breath-hold Diving
Chronic subdural hematoma (cSDH) is a collection of blood in the subdural space between the duramater and the arachnoid caused by a bridging vein rupture. One of the risk factors that can occur but rarely found is diving. Here we report a case of 20 year old patient with chronic subdural hematoma after breath-hold diving. the main complaint from this patient is headache that getting worse and he cannot do his daily activities. The patient had a history of diving 2 weeks before complaining of a headache. The CT scan of the head without contrast found that, right temporal chronic subdural hematoma, right temporal arachnoid cyst. Intracranial hemorrhage after diving was caused by barotrauma, which would cause rupture of the blood vessel due to an increase intracranial pressure. Beside that, intracranial hemorrhage can be caused by rupture arachnoid cyst.
CASE REPORT : BREAST CARCINOMA STADIUM IIIB
Introduction: Breast Carcinoma is a malignant tumor originating from the parenchymal epithelial cells of the breast. This includes the ducts of the mammary glands and their supporting tissues, which grow infiltratively, destructively, and can metastasize. In 2018, an estimated 2.1 million women were newly diagnosed with breast cancer, about one new case diagnosed every 18 seconds. The global incidence of breast cancer has increased with an annual year increase of 3.1% Case presentation: A female 51-years-old patient with right breast cancer on chemotherapy. She already has 6 times chemotherapy session the patient had a biopsy done one year ago and the results of the biopsy were obtained from a patient with grade 2 breast cancer, the patient had been offered to do breast removal but the patient refused, at this time the lump in the patient burst and bled continuously Conclusion: Breast cancer (Carcinoma mammae) is cancer of the breast tissue. Ca Mammae occurs because the condition of the cell has lost its normal control and mechanism, so that it experiences abnormal, fast and uncontrolled growth. Ca Mammae is often defined as a malignant neoplasm disease originating from the mammary gland parenchyma. There are various hormonal and non-hormonal factors that are thought to increase the risk of breast cancer, including age, genetic and familial, hormonal, lifestyle, environment, and a history of benign tumors.
CASE REPORT : DE QUERVAIN'S SYNDROME “SPECIALISTIC COMPETENCY THAT IS EASILY DIAGNOSED BY GENERAL PRACTITIONERSâ€
De Quervain syndrome is an inflammation of tendon sheath in synovial sheath covering extensor pollicis brevis and abductor pollicis longus accompanied with pain. Diagnosis can be made by general practitioner based on patient’s history, clinical findings and proper maneuver. The aim of this study is to describe the specialist competencies that can be diagnosed by general practitioners using specific examinations. Keywords : De Quervain syndrome, diagnosis, maneuver
LITERATURE REVIEW: ECTOPIC URETER IN CHILDHOOD
Ectopic ureter is a rare and often overlooked disorder of the urinary tract that can cause urinary incontinence. Ectopic ureter is thought to be caused by the ureteral bud failing to separate from the mesonephric duct, resulting in more caudal insertion. This anomaly is related to genitourinary tract embryogenesis, which results in differences in anatomical and clinical manifestations between male and female. Delayed diagnosis and treatment resulted in years of suffering and disruption to social development and school years. The urinary incontinence due to this anomaly can also cause stress urinary incontinence and psychological disorders in children. Keywords: ectopic ureter, congenital anomaly, the urinary incontinence
INITIAL HFRT EXPERIENCE ON TREATING LARGE BRAIN METASTASES LESION: A CASE REPORT
Abstract Background: Brain metastases in cancer patients are increasing, due to advances in imaging and systemic treatment. Stereotactic Radiosurgery (SRS) is a high-end radiotherapy technique that is preferred to treat small brain metastases. Hypofractionated Radiotherapy (HFRT) is an alternative technique that demand lower requirements and ideal for treating larger brain metastases. This case report intended to report our institution initial experience using HFRT in limited setting to treat a patient with large brain metastases. Case Presentation: A-43 years old women with previous breast cancer history was admitted with general weakness and severe headache since 2 weeks before admission. A CT scan exam shows multiple metastatic lesions on both parietal lobe, the largest lesion measures ≥ 3cm in diameter with a prominent vasogenic edema that caused lateral ventricle compression and mild midline shift. Discussion: SRS is preferred to treat brain metastases due to its efficacy and excellent therapeutic ratio. Unfortunately it has limitation in treating large metastatic lesions. For such lesions, HFRT being a simpler radiation technique can be opted to achieve acceptable local control and low toxicities profile. We use HFRT to treat a patient with large brain metastases lesion using IMRT with 10 x 4Gy fractionation scheme. The evaluation results 6 weeks later shows no viable brain lesion without any cognitive deterioration reported. Conclusion: HFRT for large brain metastases treatment is safe and viable to conduct in institution with limited resources. This relatively simpler technique compared to SRS should be considered to achieve acceptable therapeutic ratio with minimal toxicities.
LITERATUR REVIEW : DIAGNOSIS AND TREATMENT OF TRAUMATIC BRAIN INJURY 2022
Abstract Traumatic brain injury (TBI) is one of the leading cause of morbidity and mortality from neurological cases worldwide. TBI can result in cognitive deficits, endocrine, psychiatric disorder and affecting the capacity to work and impair the quality of life of the patients. TBI classified as mild, moderate, and severe according to the Glasgow Coma Scale (GCS). TBI can be detected from neuroimaging. This is a review from a new guideline for diagnosis and treatment of traumatic brain injury: the neuroscience of traumatic brain injury 2022. Keyword : Traumatic brain injury, neuroimaging, management, new guideline
Anal Fissure: Clinical Practice, Diagnosis in Primary Care and Management Guideline. A Literature Reviews
ABSTRACT Anal fissures or tears in the anus are very common. At least 1 in 350 people have experienced an anal fissure. About 20% of anal fissures are accompanied by hemorrhoids. However, there are still few patients or sufferers of anal fissure who know about this condition. Not many doctors or health workers are aware of how to diagnose to primarytreatment or treatment of anal fissures, so patients with anal fissures are often referred directly for surgery. In fact, anal fissures can be treated without surgery, such as dietary modifications. Surgery also has several indications and needs to be considered regarding post-operative complications that can actually be avoided. This article discusses the clinicalmanifestations, diagnosis and management of anal fissures. Keyword: anal fissure, clinical practice, primary care, management.
CASE REPORT : OLFACTORY GROOVE MENINGIOMA
Abstract Background: Olfactory Groove Meningiomas (OGM) are a rare cause of olfactory dysfunction. OGMs are benign, slow-growing tumors that cause non-specific symptoms, such as headaches, olfactory impairment, and psychiatric symptoms, such as depression, personality changes, decreased cognitive function, visual problems, or seizures. Aim: In this case report we would like to discuss about a rare case of olfactory groove meningioma with non-spesific symptoms presented in 47-year old female patient Case report: A 47-year old female with progressive blurred vision in the right eye for 3 months. Negative light perception in the right eye and fundus of the right eye indicated papillary atrophy. The direct and indirect light reflexes were negative in the right eye. We found Strong homogenous contrast enhancement extraaxial lesion accompanied by multiple dural tails in the left frontal convexity UK approximately 3.2 x 2.8 x 3.1 cm, Tuberculum sellae approximately 2.7 x 2.9 x 3 cm. Cranial decompression, frontal bone reconstruction, and tumor removal were performed. It was found that there was microcystic growth of tumor tissue, consisting of proliferation of meningoethelial cells, round to oval nuclei, smooth chromatin, visible intranuclear inclusions Discussion: OGM is a rare, benign tumor. Female patients were more likely to develop OGM than male patients. The ciliary ganglion of cranial nerve III may be affected by compression of the tumor, resulting in the absence of direct and indirect pupillary reflexes in the affected eyes. Conclusion: OGM is a slow-growing tumor that does not show significant symptoms at an early stage, making early detection difficult. Keyword: Olfactory Groove Meningioma, Blurred Vision, Meningioma
Factors Predicting Seizure Outcome After Surgical Excision Of Meningioma : A Systematic Review
Abstract Background Seizures in meningiomas occur in approximately 30% of patients. Meningiomas that press on the cortical area, as well as larger meningiomas have a greater tendency to cause focal or generalized seizures. The risk of seizures is increased in tumors that grow along the surface of the brain compared to the base of the calvaria because these tumors are more often located in areas where they can compress cortical tissue that is susceptible to epileptogenesis. The study also aimed to discuss the predictors of seizure/epilepsy in post-operative patients. Methods We searched PubMed gateway database and searched the studies published between the years 2020 and 2023. The following keywords were used to search for the specific article, single and/or in combination: meningioma, seizure, epilepsy, primary brain tumor, craniotomy, predictor, and surgery. the inclusion criteria for the studies were published in English and with “humanâ€ specified as the study category. We excluded review articles, expert opinions, and other language articles. Results We included 10 studies we found that most seizures in meningioma post-operative patients are male gender, size > 8 cm, cortical location, peritumoral edema, and history of previous seizures. The occurrence of early in-hospital seizures was associated with motor cortex involvement, postoperative Karnofsky performance score <70, postoperative complications, and preoperative seizures Conclusion This systematic review shows are several predictors that can used to predict the seizure/epilepsy outcome in patients who underwent surgery for meningioma Keywords: meningioma, post-operative, seizure, epilepsy, predictors
Pregnancy Complicated by Thyroid Heart Disease: a Case Report
Hyperthyroidism is known to give effect on cardiovascular system such as arrhythmias, vascular changes, widened pulse pressure, and myocardial remodeling. It can also affect pregnancy by harming both maternal and fetal condition. Uncontrolled thyrotoxicosis can increase the risk of complication such as preeclampsia, maternal congestive heart failure, pregnancy loss, prematurity, low birth weight, stillbirth, and IUGR. A 35 years old pregnant women presented with dyspnea since a year ago and progressively worsened since her 3rd month of pregnancy. Other symptoms were swollen legs, palpitations, thyroid enlargement, and sweating. The patient’s blood pressure was 140/50 mmHg and heart rate was 97 bpm. On physical examination, a mid-systolic scratching sound was heard over the upper part of the sternum or second left intercostal space at the end of expiration, which is called The Means–Lerman scratch that occurs in patients with hyperthyroidism. This patient Wayne’s Index was 24. Chest x-ray showed a pulmonary edema and cardiomegaly. An echocardiography revealed normal LV systolic function (EF by teich 65%), abnormal LV diastolic function grade 3, and mild concentric left ventricle hypertrophy. Laboratory results showed TSHs, FT3, and FT4 were 0.17 uIU/mL, 35.7 Pmol/L, and >100.00 Pmol/L. This patient was diagnosed with G3P2 gestational age 22-23 weeks and thyroid heart disease with heart failure preserved ejection fraction. This patient was given furosemide, propanolol, and propylthiouracil. After the symptoms subside, furosemide was discontinued. The therapy was given with monitoring of fetal heart rate and an improvement was seen throughout the hospitalization.
Heart failure, Hyperthyroidism, Pregnancy, Thyroid Heart Disease